LLD


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LLD

abbreviation for lower level discriminator.

leg length discrepancy

; LLD true leg length inequality (i.e. >1 cm difference in adult), or apparently unequal length (secondary to e.g. spinal scoliosis or pelvic tilt, so that legs function as in LLD)
  • extrinsic compensation for LLD compensatory frontal-plane adjustment, e.g. pelvic tilt (higher anterior superior iliac spine on longer leg side), spinal scoliosis (convexity toward shorter leg), pectoral tilt (lower shoulder on side of longer leg + apparently longer arm on same side as longer leg)

  • intrinsic compensation for minor LLD longer leg shows e.g. excess foot pronation, internal knee/limb rotation, lack of knee extension; shorter leg shows supination (high arch), early heel lift and genu recurvatum

  • symptoms of LLD range of pathologies relating to gait unevenness and associated symptoms of strain, e.g. neck pain, sacroiliitis, osteitis pubis, psoasitis, quadriceps strain, pes anserinus bursitis, groin (adductor) strain, knee arthrosis, anterior knee pain, peroneal tendinitis, shin splints, Achilles tendinitis, sinus tarsi syndrome, metatarsalgia, intermetatarsal neuroma and sesamoiditis (Box 1)

  • treatment of marked LLD (i.e. >3 cm LLD, e.g. secondary to limb trauma, musculoskeletal or neurological disease) provision of orthoses and bespoke prosthetic shoe incorporating whole-foot shoe raise to accommodate equinus ankle deformity of short leg

    treatment of minor LLD (i.e. <1 cm LLD) heel rise to shorter leg

  • treatment of significant LLD (i.e. 1-2 cm LLD) full biomechanical assessment and provision of bespoke orthoses, plus full-length sole raise

Box 1: Effects of limb length discrepancy
  • Increased activity of the lumbar spinal musculature to control spinal scoliosis

  • Changes in the congruency in the lumbar vertebrae and alteration to the shape of the lumbar intervertebral discs

  • Asymmetrical pelvic rotation and spinal scoliosis

  • Unilateral hip arthritis (of the longer limb)

  • Shoulder tilt and with uneven arm swing, with apparent arm length discrepancy

  • Knee pathologies and vastus medialis strain on the longer limb

  • Excessive pronation of the subtalar and midtarsal joints of the longer limb

  • Functional ankle equinus of the shorter limb (early heel lift; reduced heel strike)

References in periodicals archive ?
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Dr Mirza Ahmad LLD (Hon), MBA, LLM, Barrister Chief Legal Officer, Birmingham City Council, Ingleby House, 11-14 Cannon Street,
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